Routine inspection·August 25, 2023

On 8/25/2023 starting at 12:00 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Deogracias, Concha, care staff and explained the purpose of the visit. The facility’s fire clearance was approved for all six (6) ambulatory residents, which all 6 may be non-ambulatory. Upon entry, LPA observed two (2) staff and three (3) residents present during inspection. Starting at 12:49 PM, LPA toured facility with care staff, including but not limited to four (4) bedrooms, two (2) bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 1 bedrooms is private, 2 rooms are shared, and 1 staff room. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents'. The hot water temperature in clients’ common area bathroom was measured at 108.1 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed last serviced on 8/3/2021. First aid kit was observed to be complete. Continue on Lic809-C Continued from Lic809 Starting At 1:27 PM, LPA reviewed 3 of 3 staff records. At 1:37 PM, LPA reviewed 3 of 3 resident' records. At 2:07 PM, LPA reviewed a sample of 3 of 3 residents' medication. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. 1. At 12:57PM, LPA observed Medication and cleaning supplies unlocked and accessible to persons in care. 2. At 1:38PM, LPA observed R1, R2, and R3 with no needs and service plan on file 3. At 1:40PM, LPA observed R1, R2, and R3's Physicians reports dated for Year 2020 on file. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/1/2023: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610D Emergency Disaster Plan (9 Pages) Liability Insurance Surety bond Updated facility sketch Exit interview conducted with care staff, and a copy of this report provided along with appeal rights..